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Minister of Health Dr Aaron Motsoaledi. Picture: Gallo Images/Brenton Geach
Health Minister Aaron Motsoaledi has called for a review of remunerative work outside the public service (RWOPS) amid concerns over mismanagement, particularly regarding doctors arriving late or being absent from their duties at state-owned hospitals.
On Monday, the Office of Health Standards Compliance (OHSC) and the Health Ombud released the findings from a risk-based inspection and investigation into allegations against Helen Joseph Hospital.
This investigation followed a series of videos posted on social media in September last year by former radio talk show host Tom London.
In the videos, he alleged mistreatment, negligence, and poor infrastructure at the hospital.
While the Health Ombud on Monday said many of London’s claims were unsubstantiated, the investigation confirmed issues related to infrastructure, governance, and service delivery at the Helen Joseph Hospital.
As a result, the Health Ombud made several recommendations to the hospital’s management and the Gauteng Department of Health.
A risk assessment revealed that some doctors were arriving late to work, a problem attributed to a lack of governance and accountability at the hospital.
“The management admitted that they are struggling with doctors that are not at work at the time that they are supposed to,” OHSC Chief Executive Officer (CEO) Dr Siphiwe Mndaweni said during Monday’s press conference.
In response to questions from journalists, Motsoaledi linked part of the absence and lateness to the alleged abuse of the RWOPS system.
Under the RWOPS programme, healthcare workers are allowed to take on private sector jobs, but only if they obtain approval from their management.
“You have got to be given permission, it’s not automatic,” the minister said.
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Motsoaledi explained that RWOPS is a government initiative aimed at various sectors, including education and the police, but highlighted that it had mostly been utilised by healthcare workers.
“For some reason, it was largely with doctors.”
The minister said that nurses are primarily engaging in moonlighting within the private sector.
“Instead of going home to rest, you get a job at a private hospital where you work throughout the whole night and in the morning go to work,” he said.
Motsoaledi has stressed that the conditions under which health unions are advocating for RWOPS “no longer exist”.
“I haven’t seen the media reporting about that. The media still believes public servants are grossly underpaid,” he said, referring to the introduction of the occupation-specific dispensation (OSD).
He emphasised that many public sector doctors are now fairly compensated.
“Quite a number of people, I can say without any fear of contradiction that they are adequately remunerated, so to go and do RWOPS is grossly unfair to the public and system.”
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The OSD was introduced with the objective of negotiating and implementing new salary scales to attract and retain professionals and specialists in the public sector.
It provided significant salary increases for specific groups of state-employed doctors, including junior doctors such as interns and registrars, as well as senior doctors like principal and chief specialists.
However, Motsoaledi pointed out an unintended consequence of the OSD: some senior doctors are now declining promotions to management positions.
He explained that, in the past, hospitals were managed by superintendents — typically the most senior doctors with extensive knowledge and the authority to oversee hospital operations.
That system has since changed, which the minister described as “very unfortunate”.
“If you have got high clinical skills, the OSD pays you more money than the managers,” he said.
As a result, hospital managers are earning less than the doctors they oversee.
“It becomes very problematic because those people who must be managed are senior and the managers are junior,” Motsoaledi noted.
Motsoaledi highlighted that while clinicians who are highly sought after in the private healthcare sector can easily engage in RWOPS if they lack integrity, some still choose to refrain from it “even if we know every human being needs money”.
He said the situation becomes even more problematic when senior clinicians engage in RWOPS, as it sets a concerning precedent for junior staff.
“Many institutions, even provinces, poorly manage RWOPS because they made it automatic, while it’s not.
“Even if government gave that permission, management can refuse and say ‘no, the hospital is under-staffed; you can’t go do RWOPs’. Now, it has been made a right, which it was not.”
Motsoaledi stated that the Department of Health has notified the National Treasury and the Public Service Administration Department of its plans to reform RWOPS.
“This policy needs to be reviewed.”
The minister highlighted that the issue was even debated in Parliament, where concerns were raised that if the state took action due to the financial appeal of the private sector, doctors might simply choose to leave.
He claimed that one Member of Parliament (MP), a doctor with many years of experience, stated that doctors have already left because they are rarely present at their public hospital jobs.
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Motsoaledi suggested that it would be better if their absence were formalised to prevent doctors from claiming a government pension for work they haven’t completed.
“Most of the time they are not in and with poor management, like the one described at Helen Joseph, the managers aren’t even aware that a certain doctor was supposed to come at a specific time.”
The minister called for an urgent review of the RWOPS policy, although he acknowledged the need for such a policy in the past due to the poor remuneration of healthcare workers.
“We don’t think and believe people are poorly paid any longer in view of the changes that have taken place.”
Meanwhile, Motsoaledi explained that the abuse of RWOPS had been reported to the Health Professions Council of South Africa (HPCSA) at one point.
“Some [doctors] have even opened private practices when they are fully employed by the state.
“Unfortunately, the Health Professions Council, I must confess, didn’t do very well on this because they went to investigate and said they don’t have enough evidence to prosecute, there’s no proof, but we know it’s happening.”
He clarified that while opening a private practice was not a criminal offence, the concern arises when a state-employed doctor begins managing it.
“At what stage and at what time do you go to run it?” he asked.
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